“Months of waiting”… Lack of dermatologists, patients must wait

From Creuse (no specialist listed) to Gironde, a little better off (6.8 practitioners per 100,000 inhabitants) but forced to absorb cases from neighboring departments, this vast region of the South-West symbolizes a national shortage, synonymous for patients with “catastrophic” care pathways.

As for Dominique Estebens, 69, suddenly affected by severe plaque psoriasis in December 2023, who had to wait until the summer to be treated in Bordeaux.

“My hands were swollen, blood red, my nails were terrible.“, she tells AFP, very moved, describing the “prostration” felt “for more than six months.”I was awakened during my sleep by pain in my feet. I said to myself: +If it continues like this, I won’t be able to walk anymore+“.

This retired medical and social secretary only got an appointment with a city dermatologist in April, with unsuitable treatment, before forcing the door of the Bordeaux University Hospital in July to, finally, obtain effective care.

“You have to get into them, at the limit“, she laments. “But hey, they have a crazy job (…) They would like to take people but they are a little overwhelmed”.

“Delusional”

Same opinion for Émilie Dieda, 20 years old, suffering from vitiligo, who must schedule her dermatological follow-up appointment twelve months in advance. “You have to wait a year to be reassured, it’s horrible. It’s just crazy“, testifies the Bordeaux tourism student.

According to a map of access to care published by the Jean-Jaurès Foundation, using data from the Doctolib site, dermatologists have a median waiting time of 36 days for an appointment, the second longest behind cardiologists. (42 days).

The Foundation notes that the number of dermatologists in France (3,729, overseas territories included) has fallen by 9% since 2012.

The outlook is gloomy, due to the “numerus clausus”, a cap on the number of medical students applied in previous decades, which today makes it impossible to replace retiring practitioners, according to Professor Gaëlle Quéreux, president of the French Society of Dermatology (SFD).

From 90 trained dermatology interns, “we went up to 100 last year, she said. But we need 25 more“.

“We have ten difficult years ahead of us“, confirms Marie Beylot-Barry, head of the dermatology department at Bordeaux University Hospital. “For the patient, it means traveling a lot of kilometers, it also means months of waiting“.

These are also “loss of luck”, she emphasizes. A study carried out in the north-east of France showed that the severity of melanomas was correlated with less local access to dermatologists. “In New Aquitaine, we see more advanced cancers, coming for example from Lot-et-Garonne, even from Gironde or Charente“.

“Troubleshooting”

To remedy this, the SFD plans to set up, by 2026, traveling consultation rooms in trucks to target the most deprived areas, for an equipment and operating budget of around one million euros per vehicle.

For its part, the Bordeaux University Hospital has launched a platform for receiving photographs for general practitioners, for an initial dermatological opinion.

“Teleconsultation can be a help. But the solution is to train more dermatologists“, estimates Anne Banvillet, regional delegate of the France Psoriasis association.

This patient collective, like the French Vitiligo Association (AFV), plays an informal information and referral role for confused patients. “It’s really a big help for us“, confirms Marie Beylot-Barry. “They will not carry out consultations in place of doctors but (…) guide them towards pathways, sometimes reassuring“.

There remains the question of competition from aesthetic treatments, remunerative acts which can monopolize the agenda of certain dermatologists.

A minority, according to Gaëlle Quéreux of the SFD: according to her, more than a third of liberal practitioners “do not do aesthetics” and for those who do it, it represents “less than 10%” of their activity.

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